CMS165v13: Controlling High Blood Pressure

Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period.

Numerator

Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period

Denominator

Patients 18-85 years of age by the end of the measurement period who had a visit and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period

Patients ages 18-85 will be added to the denominator if they meet both of the following criteria:

• Encounter: The patient has an encounter within the measurement period
• Diagnosis: Have a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period

Denominator Exclusions

Patients who otherwise meet the denominator will be excluded from the denominator if any of the following is true:

• They have a past medical history of any of the following before or during the measurement period
  • Dialysis Service and Education or Vascular Access for Dialysis: They’ve had dialysis service and education before or during the measurement period, recorded in any of the following ways:
    • Text in Chart: For either, in the Plan, Assessment, Past Medical History or Review Of Systems fields of the Most Recent Encounter, include the phrase: “dialysis”
    • Dialysis Service and Education: An appropriate CPT code in the superbill
    • Vascular Access for Dialysis: An appropriate CPT code in the superbill
  • Kidney Transplant - They’ve had a Kidney Transplant before or during the measurement period, recorded in any of the following ways:
    • In the Past Medical History, Review of Systems, or Physical Exam field in the Most Recent Encounter, include the phrase: “kidney transplant”
    • ICD-10An appropriate Diagnoses code is recorded in the Problem List
    • An appropriate CPT code in the superbill
  • ESRD Monthly Outpatient Service - They have ESRD Monthly Outpatient Service before or during the measurement period, recorded with an appropriate CPT code in a superbill
  • They have any of the following diagnoses:
    • End Stage Renal Disease before or during the measurement period:
    • Chronic Kidney Disease before or during the measurement period:
    • Pregnancy during the measurement period
  • Exclude patients whose hospice or palliative care overlaps the measurement period:
    • Identified in the patient's Alerts and Directives, located in the demographic screen or the Summary Sheet, in the name, text or comments saved with that alert/directive. The Alert/Directive should include either of the following phrases:
      • palliative
      • hospice
  • Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period:
    • Accomplished with adding the appropriate billing codes for Domiciliary or rest home visit for evaluation and management. The codes are 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337
  • Exclude patients 66 - 80 by the end of the measurement period with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured:
    • Identified through a diagnosis in the chart. For a complete list of diagnosis, click HERE. Note: a diagnosis alone is not enough, the DX code must be added to the assessment and attached to the visit CPT code
  • Taking dementia medications during the measurement period or the year prior